FLORIDA STATE HOSPITAL CompKit

FLORIDA STATE HOSPITAL CompKit Competency to Stand Trial Training Resources A Comprehensive Approach to Competency Restoration Training for Criminal Defendants August 2011 Revision

FLORIDA STATE HOSPITAL CompKit Competency to Stand Trial Training Resources Instructor: COMPONENTS 1. Introduction to the CompKit Competency Recovery System 2. Access and Updates to CompKit 3. Acknowledgements 4. Considerations for Competency Instructors 5. Instructor s Manual for Teaching Factual Knowledge 6. Instructors Manual for Teaching Rational Understanding and Decision Making Defendant: 1. Competency to Proceed Fast Facts Brochure Abilite pou Ponprann Byen Vit Enfomasyon ki lan Brochi (Haitian Creole) Capacidad a Proceder Folleto Rápido de los Hechos (Spanish) Kartida Dacwad u istaagidda, Xaqiiqooyin Dhaqso ah (Somali) 2. Consumer s Pocket Guide to Competency Folleto de Capacidad de Proceder (Spanish) 3. Consumer s Competency Classroom Workbook 4. Sentences 5. Plea Bargains 6. Staying Free Resources: 1. Florida Offense Severity Ranking Chart 2. Understanding Trial Competency DVD 3. Trial Competency Education Resources CD Compiled by the Florida State Hospital Strategic Plan Workgroup for Trial Competency Education. These documents are based upon the creative enterprise of individuals and programs across the nation. CompKit: Components of the CompKit Competency Recovery System October 2010 Page 1

CompKit: Components of the CompKit Competency Recovery System October 2010 Page 2

FLORIDA STATE HOSPITAL CompKit Competency to Stand Trial Training Resources Introduction to the CompKit Competency Recovery System Competency restoration is a major concern to forensic hospitals, jails, and courts. More rapid restoration has implications for reducing crowding in jails, decreasing costs, and facilitating timely legal determinations for defendants with mental illness. Psychotropic medications and competency training are the principal treatments used for competency recovery in the United States. CompKit is designed to address the needs for materials and methods to provide effective competency training. Florida State Hospital assembled CompKit from a combination of locally developed materials and documents developed across the nation. The CompKit package includes the printed document, one compact disk (CD) containing the instructional materials, and one digital video disk (DVD) containing movies. The movies include one mock hearing, one mock trial, and competency recovery training presented as a television game show. CompKit was introduced outside Florida State Hospital at the 2007 meeting of the Forensic Division of the National Association of State Mental Health Program Directors in San Antonio, Texas. Since then, CompKit has found a place in competency restoration toolkits across the United States. Description of CompKit Crucial issues in competency training of legal concepts are to translate and simplify legal jargon and to present material at a reading level suitable for the learner. CompKit is constructed to facilitate individualized and group instruction at a variety of learner levels. Instructional materials discuss the different learning needs of different populations. To increase the motivation of learners, the instructional materials include games, a movie, and other activities designed to increase participation. Instructional design discussions highlight learning styles, cultural considerations, and educational achievement levels. Teaching approaches are discussed for different types of learners: advanced, delusional/irrational, low functioning, psychotic/confused, and disruptive. The materials provided include those for the instructor, the student, and other resource materials: CompKit: Introduction to the CompKit Competency Recovery System August 2011 Page 1

Instructor Materials The information in these sections can be use for lesson planning, classroom instruction, and student activities. Acknowledgements - Identifies and credits the contributions of the authors of these materials. General Considerations for Instructors Discusses individual differences in learning styles, cultural background, and levels of educational achievement. Instructor s Manual for Teaching Factual Knowledge - Provides thirteen teaching modules. The manual includes checklists, vocabulary list, and screening test. Instructor s Manual for Teaching Rational Understanding and Decision making Two mock trial transcripts are furnished with assorted vignettes. In addition, a group study guide is included. Student Materials These documents are designed to be provided directly to students for their use. Updated one-page brochures for defendants containing the same text are available from Florida State Hospital. Competency to Proceed Fast Facts Brochure Fast Facts is designed to be a portable and streamlined reference to competency information that learners can review at their own pace. Capacidad a Proceder Folleto Rápido de los Hechos This is the Spanish translation of the Competency to Proceed Fast Facts Brochure. Abilite pou Konprann Byen Vit Enfomasyon ki Lan Brochi This is the Competency to Proceed Fast Facts Brochure translated into Haitian Creole. Consumer s Pocket Guide to Competency The Pocket Guide is a workbook that teaches competency skills through text, quizzes, and a word game. Consumer s Competency Classroom Workbook This workbook is a classroom training resource providing comprehensive training for competency issues. It has self-tests and allows the learner to fill in answers. Sentences Outlines determinants of sentence length, tells why some people get longer sentences than others, and describes sentencing guidelines. Plea Bargains Describes the defendant s role in the plea bargain process. A tri-fold brochure for defendants containing the same text is included as an insert. Staying Free Provides guidance on probation and how adjustments to lifestyle can help a person live happier and stay out of jail. CompKit: Introduction to the CompKit Competency Recovery System August 2011 Page 2

Other Resources Offense Severity Index The Florida Offense Severity Ranking Chart lists felony offenses and categorizes them by level of severity. It should be replaced annually after legislative and statutory changes are finalized. This chart provides information only for the State of Florida, and may not be applicable to other jurisdictions. Understanding Trial Competency DVD The DVD includes a video introduction to the CompKit, movies showing a mock hearing and a mock trial, and a television style quiz program in which the moderator asks a contestant questions about competency. Trial Competency Education Resources CD This CD includes all the educational materials described. Development of CompKit Florida State Hospital has a long history of research and development in forensic assessment and treatment. As part of the hospital s continuing efforts to reduce length of stay, hospital psychologists rated medication compliance, motivation, recidivism, substance abuse, signs and symptoms of mental illness, seriousness of the alleged crime, and elements of competency for each competency evaluation for 331 persons committed to Florida State Hospital as incompetent to proceed (stand trial) over a six month period. Analyzing the data from the study yielded a model that correctly predicted 78% of the competency determination outcomes. Medication compliance and motivation to regain competency were crucial prerequisites to competency attainment, while cognitive impairment, illogical thinking, and delusions concerning the legal system and the administration of justice decreased the likelihood of person being recommended to the committing court as competent. Subsequent to this study, CompKit was compiled from new resources developed at Florida State Hospital and from existing documentation adapted from national and Florida State Hospital sources. Two core elements developed by Florida State Hospital staff, the Instructor s Manual for Teaching Factual Knowledge and the Instructors Manual for Teaching Rational Understanding and Decision Making, entered use in 2003 and were revised in 2006. The Consumer s Competency Classroom Workbook was adapted in 2003 from original materials developed by Colorado Mental Health Institute. Video training materials were developed for CompKit to help address divergent learning styles and enhance motivation, and Fast Facts was designed for use in a variety of instructional and individual settings. CompKit entered hospital-wide use in 2006 and has been revised and updated every subsequent year. Further adjustments to the CompKit package are in anticipated, and several new features are in development. Many professionals at Florida State Hospital and at other agencies contributed to CompKit. CompKit was created as part of a Florida State Hospital strategic plan to make competency recovery faster and more thorough. The hospital created a team to CompKit: Introduction to the CompKit Competency Recovery System August 2011 Page 3

coordinate development of CompKit. The team was initially comprised of: Steve Lacy, Operations Review Specialist; Wayne Anderson, Ph.D., Senior Psychologist; Ellen R. Resch, Ph.D., Director of Psychology Training, Dialectical Behavior Therapy, and Substance Abuse Services; and Lawrence V. Annis, Ph.D., Psychological Services Director. Florida State Hospital Florida State Hospital is Florida's largest and oldest residential mental health facility. Operated by the Florida Department of Children and Families, the hospital has served individuals with mental disorders since 1876. The hospital s 469-bed Forensic Service evaluates and treats more than one thousand men and women under forensic commitment per year. Other persons under commitment as incompetent to proceed or not guilty by reason of insanity reside in the hospital s 232-bed Civil Transition program, and in the 161-bed Specialty Care program. CompKit: Introduction to the CompKit Competency Recovery System August 2011 Page 4

FLORIDA STATE HOSPITAL CompKit Competency to Stand Trial Training Resources Access and Updates to CompKit Access CompKit users are reminded of our collective responsibility to use and disseminate CompKit materials and other competency to stand trial resources responsibly. When considering sharing documents from CompKit, users are asked to be sensitive regarding possible misuse by potential malingerers. Updates CompKit is regularly revised and updated with new materials. Updates to CompKit are available on request. Contact Florida State Hospital welcomes feedback concerning CompKit structure, contents and implementation. We are constantly considering how to improve the competency to stand trial recovery process. You are invited to share your comments, observations and suggestions regarding problems you encounter with CompKit, how to make it more useful, and aspects of CompKit that you believe are especially useful. The Florida State Hospital contact for CompKit is: Trina Christner-Renfroe, Psy.D. Psychological Services Director Florida State Hospital P.O. Box 1000 Chattahoochee, FL 32324 Phone: (850) 663-7706 Trina_Christner-Renfroe@dcf.state.fl.us To receive announcements of CompKit updates, please send your email address and agency name to the Florida State Hospital contact for CompKit: Want to learn more about Florida State Hospital? Visit us at our website: http://www.dcf.state.fl.us/institutions/fsh/ CompKit: Updates to the CompKit Competency Recovery System August 2011 Page 1

CompKit: Updates to the CompKit Competency Recovery System August 2011 Page 2

FLORIDA STATE HOSPITAL CompKit Competency to Stand Trial Training Resources ACKNOWLEDGEMENTS CompKit is a compilation of competency to proceed training materials from other persons and programs and original materials developed at Florida State Hospital. We gratefully acknowledge the persons and institutions whose materials were used as resources. The roster below of content providers is not inclusive: Wayne Anderson, Ph.D., Florida State Hospital Larry Annis, Ph.D., Florida State Hospital Kim Barnes, Florida State Hospital Joe Blanton, Florida State Hospital Martin Bohn, Ph.D., Florida State Hospital Shelly Brown, Florida State Hospital Robert Chitwood, Ph.D., Florida State Hospital Pete Whiddon, Florida State Hospital Trina Christner-Renfroe, Psy.D., Florida State Hospital Colorado Mental Health Institute Joe D'Agostino, Ph.D., Florida State Hospital Leslie Dellenbarger, Psy.D. Florida State Hospital Quinton Finuff, Florida State Hospital Florida Department of Children and Families Mental Health Central Office Florida Developmental Disabilities Council Florida State Hospital Educational Services Bob Gibson, North Florida Evaluation and Treatment Center Doris Green, Florida State Hospital David Gustafson, Florida State Hospital William Himadi, Ph.D., Florida State Hospital Glee Hollander, Ph.D., Florida State Hospital Karen Johnson, Ph.D., Florida State Hospital Kathi Kilpatrick, J.D., Florida State Hospital Roberet Kline, Psy.D., Florida State Hospital Steve Lacy, Florida State Hospital Steve LaRowe, Ph.D., Florida State Hospital Troy Martinez, Psy.D., North Texas State Hospital-Vernon Mike McCormick, J.D., Florida State Hospital Anthony D. McCoy, Ph.D. Florida Department of Children and Families North Florida Evaluation and Treatment Center Peter Oropeza, Psy.D., North Texas State Hospital-Vernon Judge Stewart Parsons, Gadsden County, Florida Gholam R. Pezeshkian, M.D., Florida State Hospital Tom Rankin, Florida State Hospital CompKit Acknowledgements October 2010 Page 1

Angela Register, Ph.D., Florida State Hospital Ellen Resch, Ph.D., Florida State Hospital Jeanine Revell, Florida State Hospital Linda Scott, Florida State Hospital Jacqueline Smith, J.D., Florida State Hospital Alan Steed, Ph.D., Florida State Hospital Richard Taylor, Florida State Hospital Bradley Tolstedt, Ph.D., Florida State Hospital Monica Watkins-Clay, Ph.D., Florida State Hospital Glen Watson, Ph.D. Florida State Hospital Lynne Wesby, Psy.D., Florida State Hospital Lori Yates, LMSW, RDT, North Texas State Hospital-Vernon Jacqueline Young, Florida State Hospital Tamara Young, Ph.D., Florida State Hospital Jim Warren, Florida State Hospital Michi H. Wong, Ph.D., Hawaii Forensic Mental Health Services Jane Wynn, Florida State Hospital CompKit Acknowledgements October 2010 Page 2

FLORIDA STATE HOSPITAL CompKit Competency to Stand Trial Training Resources CONSIDERATIONS FOR COMPETENCY INSTRUCTORS Several general considerations should be a part of planning competency restoration education activities. These considerations include recognition of individual differences in learning styles, cultural background, and levels of educational achievement. Addressing Individual Learning needs in Group Instruction Defendant Readiness for Instruction: Sufficient emotional stability, behavioral stability, and cognitive ability are necessary for defendants to benefit from competency instruction. Learning Styles: Different individuals learn best in different modalities. For example, some individuals learn best by visual means. Others may learn best if they hear or read the information. It is important to present material in a variety of teaching modalities or mediums to be sure that each student benefits. For example, teachers should offer written material, present material by auditory means, and present it visually. Cultural Considerations: Different students also have different backgrounds. Cultural differences and backgrounds play a part in determining how a person might best learn new material. Teachers should be aware of differing cultural backgrounds in the student group and make training activities relevant and available to residents of different geographic and cultural backgrounds. Educational Achievement Level: Florida State Hospital residents vary widely in the level of formal education that they have achieved. Some residents have graduate school experience and some barely attended school at all. For this reason, teachers should be aware of the diversity of education levels likely to be in their student population and take measures to accommodate a wide range of achievement levels. Acknowledging the above considerations, the Florida State Hospital CompKit provides information resources for competency instructors to incorporate into their lesson plans and group activities. These resources encourage instructors to present materials in a variety of formats and at a variety of levels of sophistication. The CompKit contains the basic information to be presented in all competency restoration activities provided to Florida State Hospital residents. CompKit: Considerations for Instructors October 2010 Page 1

Instructional Strategies with CompKit Duration of instruction. The time frame for instruction using CompKit is based on the individual defendant s learning capacity and the program s learning conditions. Our experience at Florida State Hospital is that it takes roughly 20 group sessions to go through CompKit with defendants who have not previously been exposed to the materials. Instruction is normally four days or five days per week. Defendants who are motivated, intelligent, and not beset with major psychotic symptoms may complete CompKit in as few as eight sessions. Defendants who are less motivated and have fewer personal and emotional resources might take more sessions, sometimes considerably more. Sequence of Instruction. We have found it helpful to go through CompKit from beginning to end. Our experience is that learner handouts, workbooks, and video instruction are more effective when integrated into an instructor-led class than when the student receives the materials without guidance and instruction. Teaching Specific Areas. Situations arise, especially in jail and outpatient settings, in which it is not necessary to teach the entire competency package. In these situations, the competency teacher may wish to select specific CompKit components to use in addressing specific defendant needs in just a few lessons or even a single lesson. If a defendant presents deficits in general education and a general overview is all that s required, the teacher might consider instruction focusing on the Fast Facts brochure. If a case is likely to conclude with a plea bargain and the defendant s main barrier is not knowing how to plea bargain, the competency teacher might use just the Plea Bargain brochure and the Sentencing brochure to help structure a lesson. Maintenance. Following initial instruction, many defendants receive maintenance instruction using CompKit materials to help them maintain their new knowledge and skills. Maintenance instruction need not be daily. Maintenance instruction may focus on knowledge and skills the defendants have initially had difficulty acquiring. If individual or maintenance-only classes are not available, defendants for whom the goal is to maintain knowledge are usually enrolled in a standard CompKit class, and participate in the same instruction as the other members of the class. Access to CompKit materials outside class. The CompKit brochures are designed to be useful to defendants in a variety of settings. We find it helpful to provide them to defendants in class, go over the contents, and encourage the defendants to keep the documents with them when they return to their residential setting. Fast Facts can be made freely available in defendants residences, waiting areas, and institutional activity settings, but there is a tendency for the brochures to be lost among the jumbles of magazines and other materials that inevitably accumulate in these places. Consequently, although we try to keep living areas supplied with Fast Facts, we offer the brochure to defendants at least weekly during competency training and on demand. CompKit: Considerations for Instructors October 2010 Page 2

After teaching ends. Three of the four brochures address fundamentals of the criminal justice process, and the fourth addresses staying out of jails and courtrooms. Learners may be offered these brochures to keep with them when they go back to jail to await adjudication. Each brochure is presented on a single sheet of standard paper with no staples or binding, which is a format generally acceptable to detention facilities. Facilitating Learning with CompKit Collaboration with service providers. While it is possible for competency instruction to proceed independently of other events in a defendant s life, two-way communication with treatment and residential service providers can accelerate learning and help overcome barriers to both competency attainment and psychiatric recovery. Instructors who know of issues in defendants lives outside of the competency classroom (e.g., medication adjustment, suspected substance abuse, hostility and agitation in the residential setting, relationship disappointments) can adjust their approach to the individual learner to encourage participation, reduce classroom stress, and avoid potential conflicts that can carry over into other residential and treatment settings. At the same time, instructors may have information regarding defendants demeanor and participation in the classroom that have implications for safety and recovery in the learners other life settings. The instructor may identify simple factors such as needing glasses that can have significant impact on competency attainment and on a defendant s life outside the classroom. Specific offenses. Our competency instructors report it is helpful for them to know the charges faced by each defendant in their class. These include charges other than the primary charge. Coordination with competency evaluation. Competency instructors with direct knowledge of a defendants progress in training may be able to signal the agents that schedule competency evaluations of the defendants readiness for professional competency examination. Access to evaluation results. Competency instructors with access to information from defendants competency evaluations can focus training on specific areas of perceived weakness. Improving competency instruction. We recommend that whenever possible, programs that provide competency recovery services maintain a forum to address challenges and share potential best practices. Challenges in Using CompKit Defendants unprepared for instruction. Some defendants may not display the ability or interest needed to benefit from competency instruction. Defendants who are not able to participate in competency instruction or demonstrate sufficient self-control may become disruptive to class and can endanger teachers and learners. It is helpful to establish behavioral and psychiatric stability minimums for participation in classroom and individual instruction. CompKit: Considerations for Instructors October 2010 Page 3

Defendants who know competency materials but cannot go to court. Our teachers sometimes encounter uncooperative defendants who have sufficient knowledge to achieve competency but do not display the emotional or behavioral skills needed to proceed in the criminal justice process. These defendants often display signs of boredom, frustration and anger if they are required to remain in competency instruction program due to psychological rather than knowledge factors. It is helpful to address their psychological needs through the usual treatment modalities instead of assuming that competency instruction will resolve these issues. CompKit: Considerations for Instructors October 2010 Page 4

FLORIDA STATE HOSPITAL CompKit Competency to Stand Trial Training Resources INSTRUCTOR S MANUAL FOR TEACHING FACTUAL KNOWLEDGE CompKit was developed in 2005-2006 by Florida State Hospital, Chattahoochee, Florida This revision: August 2011

Table of Contents Module 1. Competency education 3 Goals of competency education 3 Competency education sessions 3 Expectations at each session 3 Factors related to limited effectiveness of competency education program 4 Handling disruptive behavior in sessions 4 Module 2. General classification of incompetent to proceed residents 5 Module 3. Florida s competency to proceed factors 6 Module 4. Overview of competency to proceed 8 Module 5. Vocabulary list for competency to proceed 13 Module 6. Appreciation of charges 16 Module 7. Appreciation of possible penalties 17 Module 8. Understanding the adversarial nature of the legal process 18 Module 9. Questions about the jury 21 Module 10. Ability to manifest appropriate courtroom behavior 22 Behavior check-up (by resident) 24 Behavioral checklist (by staff) 25 Module 11. Competency education review 26 Module 12. Review of essential vocabulary for defendants 28 Module 13. Competency screening test 32 CompKit: Instructor s Manual for Teaching Factual Knowledge August 2011 Page 2

Module 1 COMPETENCY EDUCATION Goals of competency education 1. To provide the resident with accurate and relevant information about the criminal justice system 2. To set social and behavioral expectations for the resident s cooperation and participation in the criminal justice system 3. To monitor progress in stabilization of the resident s mental disorder 4. To monitor progress in ability to understand the criminal justice system 5. To assist the rest of the Service Team in narrowing the issues relevant to competency in each resident s case Competency education sessions Staff will remind participants that a successful outcome for each session requires from each participant: Attention Concentration Behavioral cooperation in group Social cooperation in group Expectations at each session Staff will remind participants at the beginning of each session of the following expectations: Participants will take part in group discussion Participants will approach program with cooperative attitude Participants will acquire a clearer understanding of the criminal justice system

Participants are free to express personal viewpoints as long as the group is not disrupted or sidetracked Factors that can limit the effectiveness of competency education Staff may observe and document these or other characteristics of residents who are experiencing difficulty in the sessions: Impaired attention Impaired concentration Impaired goal-directed, logical thought Severe suspiciousness Guardedness Hostility Personal, unrealistic beliefs involving resident s specific legal circumstances Handling disruptive behavior in sessions 1. Staff will ask participant to bring behavior in line with expectations 2. If compliance is not achieved, the participant is excused from that session 3. There will be an opportunity for the participant to comply through appropriate participation at next scheduled session CompKit: Instructor s Manual for Teaching Factual Knowledge August 2011 Page 4

Module 2 GENERAL CLASSIFICATION OF ITP RESIDENTS Many of our ITP residents can be loosely classified in terms of their competency status in one of the following ways: 1. ADVANCED/MAINTENANCE: These residents have successfully completed the competency evaluation or are close to doing so. Their knowledge is intact and their behavior is appropriate. Education sessions should focus on coping strategies, jail re-entry, and continuing treatment in jail and beyond. 2. DELUSIONAL/IRRATIONAL: These residents have an adequate awareness of their charges, the courtroom proceedings, and the likely outcome but they distort or misinterpret the reality of their particular situations. Education sessions should focus on more realistic, not irrational, coping and communication skills. 3. LOW FUNCTIONING: These residents are limited in their ability to comprehend or retain information. They need education that is remedial and information that is repeated over and over. Education sessions should focus on the role and functions of court participants, court procedures, words and terms, and possible legal consequences. 4. PSYCHOTIC/CONFUSED: These residents are poorly able to understand or communicate information because of disorganized thinking. They need treatment intervention for psychosis so it does not interfere with competency. They may not be able to benefit from attendance at education sessions; instead, they need referral to Service Team and psychiatrist. They may benefit from individual, rather than group, competency education. 5. DISRUPTIVE: These residents may display attention-seeking, impulsive, controllable or belligerent behavior that impedes learning, task completion, attention span, retaining information, or communicating. The goal with these residents is to secure their participation through reinforcement. If not, they may have to be excused from the session. They may benefit from individual, rather than group, competency education. CompKit: Instructor s Manual for Teaching Factual Knowledge August 2011 Page 5

Module 3 FLORIDA S COMPETENCY TO PROCEED FACTORS Staff teaching the competency education classes should reassure residents that they do not have to be perfect to be competent. They can have some symptoms or some problems as long as they are able to function adequately in the six areas below. Staff should also remind residents that in Florida, only a judge can determine whether or not they are competent. The hospital provides an opinion in the competency report, but the judge must rule on that opinion before the resident is truly Competent to Proceed. Florida requires that six areas be assessed in determining whether someone is competent to proceed: 1. APPRECIATION OF CHARGES: Here the resident needs to know what offense she is accused of committing, what she was arrested for, what her charge is. She should also know the legal terminology for her charge (example: Resident may know she is accused of taking a car that does not belong to her, and that this charge is called Grand Theft). She should understand the difference between being accused of committing an offense and being guilty of the offense. Note: It is not appropriate to discuss resident s actual charge in the competency education group setting. When this needed, this should be done on an individual, private basis. The group discussion should be for general education, with use of examples and hypothetical situations. 2. APPRECIATION OF POSSIBLE PENALTIES: Here the resident needs to know the options if she is convicted or if she pleads guilty or no contest. Each person s situation is different because of Florida s sentencing guidelines, but we can make reasonable estimates of the most severe penalty based on the degree of felony or misdemeanor. As above, competency education group sessions are not the place to discuss a resident s actual situation, but are a time for general information exchange. 3. UNDERSTANDING OF LEGAL PROCESS: The resident needs to know the roles and functions of the courtroom personnel, the difference between a trial and a plea bargain, relevant words and terms. CompKit: Instructor s Manual for Teaching Factual Knowledge August 2011 Page 6